title: Patients' negative emotional cues and concerns in hospital consultations: a video-based observational study.
abstract: OBJECTIVE
  Little is known about the frequency and occurrence of patients' negative emotional cues and concerns (NECC) across specialties in hospital departments.
  
  
  METHODS
  Ninety-six consultations were videotaped in a general hospital. The VR-CoDES (Verona Coding Definitions of Emotional Sequences) were used to code the patients' NECC. Cohen's kappa was used to establish reliability between coders.
  
  
  RESULTS
  Cohen's kappa was above 0.60. NECC were observed in more than half of the consultations. The number of NECC in the consultations was 163, with 109 negative emotional cues and 54 concerns. The mean number of NECC in the consultations was 1.69, with a median of 1. The first NECC in consultations were stated after a median duration of 5min 21s. We could not find significant differences related to the gender and age of the patient or the physician, or the specialty of the physician.
  
  
  CONCLUSIONS
  More than half of the concerns were not preceded by a negative emotional cue. Few consultations contained more than 3 NECC, and NECC tended to be expressed relatively early.
  
  
  CONCLUSIONS
  Patients' expressions of emotional issues are few, and most of them are subtle. Physicians should be thoroughly trained to identify and respond to them.
authors.affiliation: HØKH Research Centre, Akershus University Hospital, Lørenskog, Norway. t.a.mjaaland@medisin.uio.no
authors.forename: Trond Arne
authors.initials: TA
authors.lastname: Mjaaland
authors.forename: Arnstein
authors.initials: A
authors.lastname: Finset
authors.forename: Bård Fossli
authors.initials: BF
authors.lastname: Jensen
authors.forename: Pål
authors.initials: P
authors.lastname: Gulbrandsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003463:Cues; D004644:Emotions; D005260:Female; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D010817:Physician-Patient Relations; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D014743:Videotape Recording